Place of Death in Canada: An Analysis of the Decedent Questionnaire of the Canadian Longitudinal Study on Aging

BACKGROUND: Understanding the factors associated with the place of death is important for planning individual care and health care services. OBJECTIVES: To determine the place of death of community-living Canadians in a cohort study; and to investigate the factors associated with the location of death. DESIGN: The Canadian Longitudinal Study on Aging (CLSA) is a prospective cohort study of aging which commenced in 2010, with a sample of 51,338 community-living participants aged 45-85. There were 1287 participants with completed proxy decedent questionnaires. SETTING: The original sampling frame was from representative sampling frames across Canada. MEASUREMENTS: Community was defined as the participant's home or other non-health-care settings. Other locations were: hospice/palliative care, hospital, and nursing home/residential (long-term care [LTC]) setting. Age, sex, and income were from the CLSA survey. Cause of death, functional status prior to death, and the functional trajectory to death were from the proxy report of the decedent questionnaire. RESULTS: In total, 25% died in the community, 49% died in a hospital, 17% died in hospice/palliative care, and 9% died in LTC. Older age was associated with death in LTC. In multinomial regression models, the cause of death and the trajectory of death were associated with the place of death. CONCLUSIONS: Hospitals are the most common place of death in Canada, and different diseases and disease trajectories are associated with the place of death. These heterogeneous factors may complicate attempts to increase the proportion of people who die at home.